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Year 2 > Urinary incontinence > Flashcards

Urinary incontinence Flashcards

1
Q

What is urinary incontinence?

A

Involuntary leakage of urine

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2
Q

Urinary incontinence is common. T/F

A

True

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3
Q

Which sex experiences urinary incontinence more commonly?

A

Female

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4
Q

List the types of urinary incontinence

A

Overflow
Urge
Stress
Mixed

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5
Q

By which two means might urine leak extra-urethrally?

A

Extopic ureter

Fistula

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6
Q

Explain the normal micturition cycle

A

Storage phase - intravesical pressure lower than intraurethral pressure so urine stays in bladder

Voiding phase - detrusor contracts increasing intravesical pressure above intraurethral pressure causing relaxation of sphincters and micturition

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7
Q

What affects intravesical pressure?

A

Urine volume
Detrusor muscle
Abdominal pressure (coughing, sneezing, etc)

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8
Q

What is urodynamics?

A

An invasive test measuring pressure within the bladder and abdominal cavity and detrusor muscle pressure

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9
Q

How is a urodynamic test carried out?

A

Pressure sensor in bladder
Pressure sensor in rectum
Ask patient to cough three times - each time with more force

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10
Q

What are the components of the micturition reflex?

A

Bladder
Sphincters
Brain
Spinal bladder centre (S2-3)

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11
Q

Which nerves are involved in the micturition reflex?

A 
Pelvic parasympathetics (bladder & internal sphincter)
Pudendal (external sphincter)
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12
Q

The micturition reflex is inhibited and facilitated by descending controls from the brain. T/F

A

True

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13
Q

What causes overflow incontinence?

A

Outflow obstruction

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14
Q

How does overflow incontinence present?

A

Huge palpable bladder
Chronic retention
Enuresis
Insensible incontinence (only aware after feeling wetness)
Renal impairment (due to back pressure of urine)

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15
Q

What causes urge incontinence?

A

Detrusor overactivity

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16
Q

How does urge syndrome present?

A 
Increased frequency
Small volumes of urine
Urgency (provoked by sounds, standing, coughing, laughing, sneezing)
Enuresis
Urge incontinence
17
Q

What is detrusor overactivity?

A

Contraction of detrusor during inhibition of micturition

18
Q

How is detrusor overactivity diagnosed?

A

Urodynamics

19
Q

What causes detrusor overactivity?

A

Afferent overstimulation (stone, tumour)
Excess central facilitation (anxiety)
Paraplegia (loss of central inhibition)
Destruction of bladder centre (S2-3) - inert bag bladder
Pelvic surgery/fracture –> parasympathetic nerve damage
Idiopathic

20
Q

What is damage to parasympathetic nerves associated with?

A

Higher risk of infection

21
Q

What nerve is not affected when parasympathetic nerves are damaged?

A

Pudendal!

22
Q

How does idiopathic detrusor overactivity usually present?

A

Older woman
Urgency
Frequency
Urge incontinence

23
Q

What is (urodynamic) stress incontinence?

A

Leakage of urine during increased intra abdominal pressure WITHOUT detrusor contraction

24
Q

What causes stress incontinence?

A

Damage to pelvic floor
Damage to urethral function

i.e child birth

25
Q

How is stress incontinence diagnosed?

A

Urodynamics

26
Q

When might frequency occur with stress incontinence? Which symptom should not be present?

A

As a learned behaviour to try and prevent/reduce incontinence
Urgency

27
Q

How should the bladder feel on examination (if it is full)?

A

Painless mass arising from pelvis
Cannot “get below it”
Dull to percussion

Nb - in female patients it could be pregnancy

28
Q

How is overflow urinary incontinence treated?

A

Assessment of renal function
Catheterisation to treat obstruction
Rehabilitation of bladder (teach how to self catheterise)

29
Q

How is urge urinary incontinence treated?

A 
Avoid caffeine 
Bladder retraining 
Timing of bladder emptying 
Pharmacotherapy 
Neuromodulin (pacemaker)
Enterocystoplasty
30
Q

Which pharmacological options are available in the treatment of urge incontinence? What are the side effects?

A

Anti-muscarinics e.g oxybutinin, tolterodine (dry mouth)

Beta 3 adrenergic i.e mirabegron

31
Q

How is stress incontinence treated?

A 
Weight loss
Smoking cessation
Physiotherapy (pelvic floor exercises)
Pharmacotherapy (not useful)
Surgery (open vs tape)
32
Q

How is mixed incontinence treated?

A

Combination urge and stress treatment approach

33
Q

What are risk factors for urinary incontinence in the elderly?

A 
Dementia
Immobility
Drugs (diuretics, sedatives) 
Obstruction --> overflow
Neuropathy 
Weak pelvic floor
34
Q

Ectopic ureters are congenital. T/F

A

True

35
Q

What is the cause of most vesico-vaginal fistula?

A

Prolonged obstructed labour

36
Q

What is urgency?

A

Sudden, compelling desire to pass urine

37
Q

List some voiding symptoms

A

Slow stream
Abnormal stream (splitting)
Hesitancy
Straining

38
Q

What is a frequency volume chart?

A

Used to measure urine output (& at which time of day) for at least 24 hours

Year 2 (72 decks)

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